Provider Demographics
NPI:1215587597
Name:HAWTHRONE, KRISTY R (OTA)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:R
Last Name:HAWTHRONE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:COUFAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 JACKIE RD SE STE 900
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6612
Mailing Address - Country:US
Mailing Address - Phone:505-289-1042
Mailing Address - Fax:505-466-5895
Practice Address - Street 1:1316 JACKIE RD SE STE 900
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6612
Practice Address - Country:US
Practice Address - Phone:505-289-1042
Practice Address - Fax:505-466-5895
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4185224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant